Urinary tract infection after kidney transplant. Incidence and predisposing factors. Experience at an Argentinian Health Center

GARCIA MR; ABALOS A; UVA P; SABBATIELLO R; SCHIAVELLI R

Vancouver

Congreso; 23 Intenational Meeting of the TTS; 2010

The Transplantation Society - TTS

INTRODUCTION: Post-trasplant urinary tract infections are important because of their influence on recent kidney transplant patients and their outcomes. The incidence of urinary tract infections (UTI) varies from 35% to 79% in different series, and  approximately 60% of bacteremias are originated in the urinary tract. OBJECTIVES: To determine: Incidence of UTI during the first year after Kidney Transplant (KT), and predisposing factors for UTI. If UTI occurred during first month after KT predispose to reinfection. MATERIAL AND METHODS: Our database for the research was medical records of 218 KT performed at our hospital from 01-012002 to 12-31-2008. Our hypothesis was that UTI occurred during the first month after KT was a major determinant of infectological graf outcomes and a predisposing factor to reinfection. We analized demographic variables; renal, urological and infectological  antecedents as well as post-surgery variables ?inmunological and not. RESULTS: Between the first and the twelveth month after KT the incidence of UTI was 28.9%, from now on referred as UTI Group (UTIG). The rest of the recipients were named as Control Group (CG). When it comes to the age, those whose age was 40 or above had an incidence of UTI of 36.4%; while it was 23.1 % for those below 40 (p<0.04). With respect to gender, 37% of female were on UTIG, while 23% of male did (p<0.03). Among the patients that had urological complications (UC) 40.8% were at UTIG vs 25.4% at CG (p<0.04). 47.5% of those that had UTI during first month after KT were at UTIG vs 22% of whom didn´t have it (p<0.001). On multivariate analysis we found as independent predisposing factors for UTI the presence of UTI during the first month after KT (p<0.02), we analized this subgroup and revelead: The incidence of UTI during first month after KT was 27.1% (named as UTIG1), the rest of the patients were named as ?Control Group 1? (CG1). Among the patients that had UC, 55.1% were at UTIG1 (p<0.001). Among the patients whose vesical catheterism (VC) was drawn before day 8, the incidence of UTI was 22.5%. The incidence of UTI reached 62.5% in those patients that had VC drawn on day 8 or after (p<0.01). 45-year-old patients or older had UTI in 40.5% (p<0.002).Younger patients had UTI in 20.4% of the cases. On complete multivariable analysis we found as independent determinants of UTI during the first month after KT those 45-year-old or older patients (p<0.002) and those with UC (p<0.002). CONCLUSIONS: The incidence of UTI during the first year after KT was 43.1%. The major determinant of UTI between first and twelveth month after KT was UTI during the first month. UTIG1 predisposing factors are the time of VC, the presence of UC, and age above 45. Especially, these last two determinant factors show a greater risk independent of other variables. These findings show risk factors for UTI on KT recipients, inviting us to take actions to prevent them and to keep working to optimize the treatment on this risk group.   Disclosure: All authors have declared no conflicts of interest.